System for Opioid Overdose Surveillance (S.O.S.) Mahshid Abir, MD, - - PowerPoint PPT Presentation

System for Opioid Overdose Surveillance (S.O.S.)

Mahshid Abir, MD, MSc Rebecca Cunningham, MD Amy Bohnert, PhD, MHS October 22, 2018

Disclosure

• This project is funded by the UM Injury Prevention Center,

Michigan HIDTA, and the Michigan Department of Health and Human Services (MDHHS)

https://www.cdc.gov/drugoverdose/data/index.html

Opioid Crisis: View from the Frontline

Opioid Overdose: Tip of the Iceberg

Challenges of Surveillance in Michigan

• Emergency medical services (EMS) naloxone

deployments can be tracked through the Michigan EMS Information System (MI-EMSIS)

• Emergency department (ED) data is not centralized

– No system currently tracks ED overdoses statewide

• Medical examiner (ME) data is not centralized

– Current fatal overdose data lags 18 months statewide

System for Opioid Overdose Surveillance (S.O.S.)

Note: Example of geo-coding hot spots. This is NOT real data.

• Scalable—By using the

minimum number of datasets to obtain the most relevant data

• Maximizes limited

resources—By identifying “hotspots” of fatal and non- fatal overdose

• Timely and accurate—By

providing overdose data that is not over- or under-counted

Phase 1: Washtenaw County Pilot

Medical Examiner

Washtenaw County

EMS

Huron Valley Ambulance

Emergency Departments

Michigan Medicine

• St. Joseph Mercy

Health

Opioid Overdose Non-fatal Locations

Washtenaw County: Jan. 1, 2017-Dec. 31, 2017

Blue = Residence Location Green = Incident Location Data sources: Huron Valley Ambulance, Michigan Medicine, St. Joseph Mercy Health Hot spots found in zip codes: 48109, 48104, 48198

Opioid Overdose Fatal Locations

Washtenaw County: Jan. 1, 2017-Dec. 31, 2017

Data sources: Washtenaw County Medical Examiner, Michigan Medicine emergency department, St. Joseph Mercy Health emergency department

Red = Incident Location Blue = Resident Location Hot spots found in zip codes: 48109, 48104, 48198

S.O.S. Expansion to 3 HIDTA Counties by end of 2018: Washtenaw, Kent, Muskegon

• Obtain EMS data through MI-EMSIS

database

• Partnership with Great Lakes

Health Connect (GLHC) to obtain real-time ED overdose data from the lower peninsula

– Cannot be used for research

• Partnership with MDILog to obtain

real-time ME overdose data

– Used in 42 of 83 (50%) Michigan counties

• Further develop the S.O.S. interface

Medical Examiner

MDILog death database

EMS

MI-EMSIS

Emergency Departments

HIE Company: Great Lakes Health Connect

Standardize & Match Data

S.O.S. Interface

About page

S.O.S. Interface

Emergency Department

Opioid Overdose Emergency Department visits by County Michigan Medicine ED, 1/1/2017-10/25/2017

S.O.S. Interface

Detail Map: EMS Incident Locations

EMS, Emergency Department, and Medical Examiner 1/1/2017-10/25/2017

S.O.S. Interface

Detail Map: Fatal Heatmap

EMS, Emergency Department, and Medical Examiner 1/1/2017-10/25/2017

S.O.S. Interface

Emergency Department

S.O.S. Capabilities

• Non-fatal Overdoses

– EMS: Update 3 times a week – ED: Update every 24 hours

• Fatal Overdoses (ODs)

– Update suspected ODs every 24 hours – Confirm ODs after toxicology results are obtained ~90 days later

• Linkage of 3 datasets- eliminates over counting of EMS and fatal

ED visits

• Presents both rates and raw numbers of events
• Provides both location of home and location of death for fatal
• verdoses and non-fatal EMS: allows for tracking of movement
• County level data available to the public
• Census tract data password protected for key stakeholder access

Next Steps

• Continue expanding

surveillance to remaining 9 High Intensity Drug Trafficking Areas (HIDTA) counties

• Ultimate goal of

statewide surveillance in the next 3 years

Implications

• S.O.S. allows both public health

to:

• 1. Continuously follow the size,

spread, and trends of non- fatal and fatal overdoses

• 2. Implement interventions in

communities where they are most needed

• 3. Inform allocation of

resources